Department of Sociology, University of York, UK.
J Int AIDS Soc. 2011 Sep 27;14 Suppl 2(Suppl 2):S4. doi: 10.1186/1758-2652-14-S2-S4.
Randomized controlled trials and critical social theory are known not to be happy bedfellows. Such trials are embedded in a positivist view of the world, seeking definitive answers to testable questions; critical social theory questions the methods by which we deem the world knowable and may consider experiments in the biomedical sciences as social artifacts. Yet both of these epistemologically and methodologically divergent fields offer potentially important advances in HIV research. In this paper, we describe collaboration between social and biomedical researchers on a large, publicly funded programme to develop vaginal microbicides for HIV prevention. In terms of critical engagement, having integrated and qualitative social science components in the protocol meant potentially nesting alternative epistemologies at the heart of the randomized controlled trial. The social science research highlighted the fallibility and fragility of trial data by demonstrating inconsistencies in key behavioural measurements. It also foregrounded the disjuncture between biomedical conceptions of microbicides and the meanings and uses of the study gel in the context of users' everyday lives. These findings were communicated to the clinical and epidemiological members of the team on an ongoing basis via a feedback loop, through which new issues of concern could also be debated and, in theory, data collection adjusted to the changing needs of the programme. Although critical findings were taken on board by the trialists, a hierarchy of evidence nonetheless remained that limited the utility of some social science findings. This was in spite of mutual respect between clinical epidemiologists and social scientists, equal representation in management and coordination bodies, and equity in funding for the different disciplines. We discuss the positive role that social science integrated into an HIV prevention trial can play, but nonetheless highlight tensions that remain where a hierarchy of epistemologies exists alongside competing paradigms and priorities.
随机对照试验和批判性社会理论并不是一对“快乐伴侣”。这类试验根植于实证主义世界观，旨在针对可检验的问题得出明确的答案；而批判性社会理论则对我们认为可以认识世界的方法提出质疑，并可能将生物医学科学中的实验视为社会产物。然而，这两种在认识论和方法论上截然不同的领域都有可能为艾滋病研究带来重要进展。本文描述了社会和生物医学研究人员在一个大型公共资助项目中的合作，该项目旨在开发用于艾滋病预防的阴道杀微生物剂。从批判性参与的角度来看，在方案中纳入综合的和定性的社会科学内容意味着在随机对照试验的核心中潜在地嵌套了替代的认识论。社会科学研究通过展示关键行为测量中的不一致性，突出了试验数据的易出错性和脆弱性。它还突出了生物医学对杀微生物剂的概念与使用者日常生活中对研究凝胶的意义和用途之间的脱节。这些发现通过反馈循环不断传达给团队中的临床和流行病学成员，通过这种循环，还可以讨论新出现的关注问题，并在理论上根据项目的变化需求调整数据收集。尽管试验人员接受了批判性的发现，但仍然存在一个证据等级，限制了一些社会科学发现的实用性。尽管临床流行病学家和社会科学家之间相互尊重，在管理和协调机构中具有平等的代表性，并且为不同学科提供了平等的资金，但情况仍然如此。我们讨论了将社会科学纳入艾滋病预防试验中可以发挥的积极作用，但同时强调了在存在认识论等级制度以及相互竞争的范式和优先事项的情况下仍然存在的紧张关系。
